Kuenzanisa kubhadhara kunoitika mushure mekunge mabhadhara mari yenyu yakabhadhara , mari yekubhadhara kana mari yekubhadhara uye yekambani yenyu yehushuwarisi yakabhadhara zvose zvinosungirwa kuti zvibhadhere kumutero wako wekurapa. Kana kuchiripo chikwereti chikwereti pane icho chikwereti uye chiremba kana chipatara chinotarisira iwe kubhadhara chikamu ichocho, iwe uri kuenzanirana kuripo.
Kuenzanisa Mutemo Wemitemo Here Kana Kuti Kwete?
Dzimwe nguva zviri pamutemo, uye dzimwe nguva hazvisi; zvinoenderana nemamiriro ezvinhu nemitemo yenyu yveshuwarisi.
Kuenzanisa kubhadhara kunowanzomutemo:
- Apo iwe une Medicare uye uri kushandisa mutano wehutano uyo anogamuchira Medicare basa.
- Paunenge uine Medicaid uye mutapi wako wehutano ane chibvumirano neMedicaid.
- Apo chiremba wako kana chipatara ane kambani neurongwa hwehutano hwako uye anokubhadhara iwe kupfuura iyo iyo kambani inobvumira.
Mune imwe neimwe yezviitiko izvi, chibvumirano pakati pemutano wehutano neMedareid, Medicaid, kana kambani yako yveshuwarenzi inosanganisira gwaro rinorambidza kubhadhara kubhadhara. Somuenzaniso, apo chipatara chinoratidzira neMedarere kuona varwere veMedare, inofanira kubvumirana kugamuchira Medicare negotiated rate, kusanganisira kubhadhara mari yako, sekubhadhara zvakakwana. Izvi zvinonzi kunogamuchira Medicare basa .
Kuenzanisa kubhadhara kunowanzomutemo:
- Paunenge uchishandisa mutano wehutano uyo asina ukama kana chibvumirano neye insurer yako, Medicare, kana Medicaid. Izvi zvakajairika mumagariro ekurapa , uye ndeyewo nyaya kana iwe uchitsvaka kunze kwehutano hwehutano urongwa hwehutano. Chirongwa chako chinogona kuvhara zvimwe kunze kwe-network mari, asi kunze kwe-network provider haafaniri kubvumirwa kubvuma kubhadhara yako insurer sekubhadhara kwakakwana; vanogona kukutumira iwe gwaro rezvimwe zvinosara, kunyange kana zvakanyanya kupfuura chirongwa chako chekunze-che-network copay kana kubviswa.
- Paunenge uchiwana maitiro asina kuvharwa nehutano hwehutano inshuwarheni, kunyange iwe uri kuwana mavhisi aya kubva kune uyo anopa chibvumirano neurongwa hwehutano hwako. Izvi zvinowanzoitika pakugadzira zvipfeko izvo zvisina kudikanwa mumishonga. Muchiitiko ichi, iwe uchava nemhosva yebhorodha rose.
Sezvo inshuwarano yehutano inotungamirirwa nehurumende imwe neimwe, mitemo yehurumende inogona kuchinja kana uye kana chikwereti chekubhadhara chiri chepamutemo. Mamwe magwaro ane mitemo yakananga pamusoro pekuenzanisa kubhadhara kunopesana nemitemo inokosha pamusoro apa. Dzidza zvakawanda pamusoro pemitemo yehurumende pamari yekubhadhara kubva kuKaiser Family Foundation.
Iko Balance Billing Works
Apo iwe unotarisira kubva kune chiremba, chipatara, kana mumwe mutapi wehutano uyo hausi chikamu che insurer yako mupiki wekutengesa (kana, kana iwe une Medicare, kubva kune waunopa asingagamuchiri Medicare basa), uyo mutarisiri wehutano anogona anokupa mhosva chero chaanoda kukubhadhara. Sezvo kambani yako yehushuwarisi isina kutaurirana chero zvipi zvayo nemupi wehupi, iye kana akasungwa nechibvumirano neurongwa hwehutano hwako.
Kana kambani yako yehutano inshuwarani inobvumirana kubhadhara chikamu chekubuda kwako kwe-network , hurongwa hwehutano hahuri kubhadhara chikamu chezvakanyatsobhadharwa. Pane kudaro, inobhadhara chikamu chezvarinoreva zvinofanira kunge zvakabhadharwa, zvisingazivikanwi sechinhu chakanaka uye chetsika . Sezvaunogona kufungidzira, mari inonzwisisika uye yowsika inowanzopera kudarika chikamu chauri kutengesa. Mari yekusungirirwa inobva pakusiyano pakati pezvaunoti insurer yako inonzwisisika uye tsika, uye izvo chiremba kana chipatara chiripo.
Heano muenzaniso wekuchengetwa kwevakaremba ne 20% coinsurance ye-in-network hospitali uye 40% coinsurance ye-out-of-network hospitali:
| In-network chipatara (20% coinsurance) | Out-of-network chipatara (40% coinsurance) ne balance balance | |
| Chipatara chinopomerwa | $ 60,000 | $ 60,000 |
| Inishuwarenzi inobatanidza kuderedzwa kwehuwandu hwe | $ 40,000 | Hakusi purofu nokuti chipatara ichi chiri kunze kwe-network |
| Insurer inonzwisisika uye tsika yemitambo | $ 45,000 | |
| Inishuwairi inobhadhara | $ 32,000 (80% ye $ 40,000 kutengesa muzinga) | $ 27,000 (60% ye $ 45,000 inonzwisisika uye tsika yemitambo) |
| Iwe unobhadhara coinsurance ye | $ 8,000 (20% ye $ 40,000) | $ 18,000 (40% ye $ 45,000) |
| Balance billed amount | $ 0 | $ 15,000 (Chipatara chepakutanga chikwereti chine inshuwarisi uye mari yekubhadhara mari) |
| Kana uchibhadharwa zvakakwana, iwe wakabhadhara | $ 8,000 | $ 33,000 (Your coinsurance pamwe chete nemari yakasara.) |
Kuenzanisa Kunini Kuitika?
MuUnited States, kubhadhara kubhadhara kunowanzoitika apo iwe unotarisira kubva kune chiremba kana chipatara icho chisati chiri chikamu chehutano hwekambani yehutano yekambani yemukati kana asingagamuchiri Medicare basa.
Kushamisika Kuenzanisira Kubhadhara: Kunze kwe-Network Providers Kushanda paIn-Network Facilities
Izvi zvinogona kuitika zvisingafungi, kunyange kana iwe uchiedza kugara mu-network. Somuenzaniso, unoenda kuchipatara che-in-network, asi radiologist uyo anoverenga yako-ray haisi mu-network. Bhiri rinobva kuchipatara rinoratidza in-network rate uye haisi pasi pekubhadhara kubhadhara, asi radiologist, sezvo asina chikamu nemudzidzisi wako, anogona kukubhadhara chero chaanoda uye akasununguka kuenzanisa mari. Mamiriro akafanana akadai ne:
- Anesthesiologists
- Pathologists (laboratory doctors)
- Neonatologists (vanachiremba vezvitsva)
- Intensivists (vanachiremba vanonyanya kuongorora zvirwere zve ICU)
- Vanachiremba (vanachiremba vanoziva muzvipatara varwere)
- Radiologists (vanachiremba vanoshandura x-rays uye zvikwangwani)
- ER vanachiremba
- Durable imishonga yezvokurapa vanotengesa (kureva, iyo kambani inopa michina, mabhesi, maguruvhesi, nezvimwe izvo vanhu vanoda mushure mekurapa)
- Nheyo dzakagamuchirwa kubva kumubatsiri akasarudzwa nomumwe munhu. Izvi zvinogona kuitika kana une p-smear kana bhiopsy yakaitwa muhofisi yechiremba, kana ropa rinotorwa nemukoti wehutano hwemusha. Kana chiremba wako kana mukoti akatumira mutsara kune imwe kunze-ye-network labor, iyo labori inogona kuenzanisa mari iwe.
Izvi zvinokanganisa kutarisa mamiriro ezvinhu zvinonyanya kupisa varwere, avo vanowanzotenda kuti chero bedzi vakasarudza nzvimbo ye-in-network yezvokurapa, zvose zvavanotarisira zvicharatidzwa pasi pe-in-network mazwi echirongwa chehutano hwavo. Kutarisana nemamiriro ezvinhu aya, nyika dzakawanda dzakagadza mitemo yekuchengetedza vatengi inogadzirisa kushamiswa kwemari yekubhadhara (zvakakosha kuziva kuti mitemo yenyika inowanzoshanda kune zvirongwa zvehutano zvakarongedzwa nehurumende. Zvirongwa zvehurumende, izvo zvinoshandiswa nevashandirwi vakawanda, zvinotungamirirwa nemutemo wehurumende, pasi pe ERISA):
- Arizona yakagadzirirwa Senate Bill 1441 muna 2017. Ichatanga kushanda muna 2019, uye ichabvumira varwere vanogamuchira mari inoshamisika yebhadharo (kubva kunze kwe-network-provider uyo akaita mabasa kune-network network) ye $ 1 000 kana kupfuura kuti atsvake kubvumirana. Iyo yekugadzirisa hurumende ichazogadzirisa dambudziko iri pakati pechipatara nekambani ye inshuwarisi, nokudaro kusunungura murwere wemhosva yebhadharo yemari.
- New York yakachengetedza varwere kubva kushamisika kutengesa kubhadhara kubva muna 2015.
- California yakagadza AB72 muna 2016; inoshanda kumapurogiramu akabudiswa kana kuvandudzwa mushure kana shure kweJuly 1, 2017, uye kudzivirira varwere kuti vaifanira kubhadhara kunze-kwe-network mari yekuchengetwa yakagamuchirwa pa-in network network.
- Florida yakagadzwa HB221 muna 2016. Mutemo unochengetedza varwere kushamisika kutengesa kubhadhara mumamiriro ezvinhu akaoma uye mumamiriro ezvinhu apo murwere anotsvaka kutarisirwa pane imwe nzvimbo-network nzvimbo uye anozobatwa-pasina imwe sarudzo-nekunze kwe-network kupa mukati nzvimbo.
- Maryland, Illinois, uye Connecticut vanovewo nemitemo inodzivirira vatengi kubva pakushamisika kubhadhara billing. Dzimwe dzakawanda dzakawanda dzinodzivirira zvishoma munzvimbo.
Kuenzanisa kubhadhara hakuwanzoitiki ne-in-network providers kana vateresi vanogamuchira Medicare basa nokuti, kana vachikwereta mari iwe, vanopesana nemitemo yesangano ravo neye insurer kana Medicare. Vanokwanisa kurasikirwa nechibvumirano, kutarisana nemari, kutambudzwa zvakanyanya, uye kunyange kutarisana nemhosva kune dzimwe nguva.
Izvo zvisingaiti izvi zvinoitika apo uri kushandisa in-network kupa, asi uri kuwana basa risina kuvharwa nehutano inshuwalhu yako. Sezvo inshuwarisi isingatauri maitirwo emabasa asina kuvhara, iwe hauna kudzivirirwa neyo inshuwarisi-yakatorwa zvishoma. Mupiro anogona kutengesa chero zvaanoda, uye iwe uri mutoro webhadharo rose.
Kana Uri Kuenzanisa Kunobhadharwa
Kana iwe wakagamuchira bhadha yemari kana uri kufunga nezvekuwana rubatsiro rwehutano huchaita kuti uwane mari yekubhadharisa, iwe une zvimwe zvasarudzo zvekuti ungagadzirisa sei mamiriro acho ezvinhu. Dzidza kuti ndezvipi zvaunosarudza uye nzira dzamungashandisa kuti uone kubhadharwa kubhadhara mu " Kuenzanisa Kwekubhadhara-Kutora Kwazvo, Zvaunofanira Kuita ."
> Sources:
> Commonwealth Fund. Kuenzanisa Kubhadhara Nehutano Hwokupa Utano: Kuongorora Vatengi Kudzivirira Munyika Yose
> United States Department of Labor. Mubasa Retirement Revenue Income Security Act.